Postoperative Infections in Interbody Fusion for Degenerative Spinal Disease

Pappou, Ioannis P.; Papadopoulos, E.; Sama, Andrew A.; Girardi, Federico P.; Cammisa, Frank P.

doi:10.1097/01.blo.0000203446.06028.b5

Cited by 56 publications

(53 citation statements)

References 27 publications

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“…Patients with infection can have good to excellent clinical outcome, with no long-term loss of function [55,56], similar to noninfected patients [1]. In their retrospective case-control study on 32 patients with deep wound infection, at mean follow-up of 62 months, Mok et al [1] reported no significant difference in Physical Function, Role Physical, Bodily Pain and General Health domains between infection and control groups in the SF-36 Health Survey.…”

Section: Clinical Outcomementioning

confidence: 99%

Infections in spinal instrumentation

Gerometta

Olaverri

Bitan

2012

International Orthopaedics (SICOT)

123

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Surgical-site infection (SSI ) in the spine is a serious postoperative complication. Factors such as posterior surgical approach, arthrodesis, use of spinal instrumentation, age, obesity, diabetes, tobacco use, operating-room environment and estimated blood loss are well established in the literature to affect the risk of infection. Infection after spine surgery with instrumentation is becoming a common pathology. The reported infection rates range from 0.7% to 11.9%, depending on the diagnosis and complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. These infections after instrumented spinal fusion are particularly difficult to manage due to the implanted, and possibly infected, instrumentation. Because the medical, economic and social costs of SSI after spinal instrumentation are enormous, any significant reduction in risks will pay dividends. The goal of this literature review was to analyse risk factors, causative organisms, diagnostic elements (both clinical and biological), different treatment options and their efficiency and consequences and the means of SSI prevention.

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Section: Clinical Outcomementioning

confidence: 99%

Infections in spinal instrumentation

Gerometta

Olaverri

Bitan

2012

International Orthopaedics (SICOT)

123

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“…Despite advances in prophylaxis, the incidence of deep infection after instrumented spinal surgery remains between 0.4% and 4.3% 14,16,19) and may be higher in patients undergoing fusion after spinal trauma 26) . Although infection can be a disabling complication of any surgical procedure, spinal infection can be particularly devastating due to the close proximity of the neurological structures.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Serum CRP and Procalcitonin in Patients after Spine Surgery

Chung

Won

Kwon

et al. 2011

J Korean Neurosurg Soc

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in a single institution. Exclusion criteria were as follows : preceding the spine surgery in the previous 2 weeks, preexisting or postoperative infection, being less than 18 years of age, and being discharged less than 5 days after the spinal surgery. Clinical data relevant to the study included age, sex, body mass index (BMI), BT, site and type of surgery, and surgery duration.All patients received a preoperative antibiotic prophylaxis with a first generation cephalosporin, cefazolin, and also postoperative antibiotics were injected through their fourth postoperative day. All patients were operated under general anesthesia and received daily clinical examinations until discharge. INTRODUCTIONDespite advances in prophylaxis, the incidence of deep infection after instrumented spinal surgery remains between 0.4% and 4.3% 14,16,19) and may be higher in patients undergoing fusion after spinal trauma 26) . Although infection can be a disabling complication of any surgical procedure, spinal infection can be particularly devastating due to the close proximity of the neurological structures. Early detection of an infection may prevent substantial problem later.It is often difficult to diagnose postoperative spinal infection before clinical symptoms become apparent. Magnetic resonance imaging can help to diagnose the soft-tissue change but is expensive to use as a screening tool and may not be available. Although inflammatory markers, such as C-reactive protein (CRP), white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and body temperature (BT), easily are measured, their specificities are not high.In a recent meta-analysis, procalcitonin (PCT) was superior to Objective : Classical markers of infection cannot differentiate reliably between inflammation and infection after neurosurgery. This study investigated the dynamics of serum procalcitonin (PCT) in patients who had elective spine surgeries without complications. Methods : Participants were 103 patients (47 women, 56 men) who underwent elective spinal surgery. Clinical variables relevant to the study included age, sex, medical history, body mass index (BMI), site and type of surgery, and surgery duration. Clinical and laboratory data were body temperature, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and PCT, all measured preoperatively and postoperatively on days 1, 3, and 5. Results : PCT concentrations remained at <0.25 ng/mL during the postoperative course except in 2 patients. PCT concentrations did not correlate with age, sex, DM, hypertension, BMI, operation time, operation site, or use of instrumentation. In contrast, CRP concentrations were significantly higher with older age, male, DM, hypertension, longer operation time, cervical operation, and use of instrumentation. Conclusion : PCT may be useful in the diagnosing neurosurgical patients with postoperative fever of unknown origin.

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“…The reported rates of SSI in after open spine surgery vary from 0.7% to 16% [10][11][12][13][14][15][16][17][18][19][20][21][22] .…”

Section: Discussionmentioning

confidence: 99%

Does Spondylodiscitis Follow All Its Parameters? - Report of Three Atypical Cases

Roy¹

2017

jmscr

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Vertebral osteomyelitis or spondylodiscitis is 2-7% of osteomyelitis. Iatrogenic spondylodiscitis accounts for 1-11%. Common organism is Staphylococcus aureus and usually the mean time from onset of symptoms to diagnosis has been reported to range from 8 weeks to 3 months. Worsening back pain with reduced spinal ROM is sine qua non on iatrogenic spondylodiscitis. CRP and ESR are most important prognostic factors of treatment. In this report I present three cases one which started florid infections and its signs and symptoms much later than documented times after operation, one who developed post procedural discitis by an atypical bacteria without any definite cause of it to do it, one with indolent tunneling infection of the vertebral body after minimally invasive discectomy without any considerable alteration in clinicalfunctioning but with alteration radiologically and biochemically.

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Postoperative Infections in Interbody Fusion for Degenerative Spinal Disease

Abstract: Therapeutic study, level IV (case series). Please see the Guidelines for Authors for a complete description of levels of evidence.

Cited by 56 publications

References 27 publications

Infections in spinal instrumentation

Infections in spinal instrumentation

Comparison of Serum CRP and Procalcitonin in Patients after Spine Surgery

Does Spondylodiscitis Follow All Its Parameters? - Report of Three Atypical Cases

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